Domino Reconstruction of the Portal Vein Using the External Iliac Vein and an ePTFE Graft in Pancreatic Surgery

J Gastrointest Surg. 2017 Aug;21(8):1278-1286. doi: 10.1007/s11605-017-3413-2. Epub 2017 Apr 4.

Abstract

Background: In the portal vein resection of long distance, an interposition by autologous vein is mandatory. External iliac vein (EIV) has been used, but harvesting the EIV is associated with severe venous congestion of the affected lower extremity. We have reconstructed the EIV using a ringed expanded polytetrafluoroethylene (ePTFE) graft.

Methods: Thirteen patients underwent this surgery. The right EIV was used for reconstructing the portal vein, and the retrieved portion of EIV was interposed by the ePTFE graft. We evaluated size and length of the graft, graft patency, girth of thigh, time for reconstruction of EIV, and graft infection.

Results: ePTFE grafts of 8 or 10 mm in diameter were used. The length of ePTFE graft used was 4.4 ± 0.5 cm. Graft patency was kept in 76.9% patients. Graft obstruction was encountered in three patients, and the girth of right thigh increased by about 10 cm. Time for reconstruction of EIV was 29.5 ± 6.8 min. Graft infection did not occur in any patients.

Conclusions: Reconstruction of the EIV using a ringed ePTFE graft seems to be a feasible option for preventing the swelling of the affected lower extremity after procurement of EIV for repairing the portal vein.

Keywords: Graft; Iliac vein; Portal vein; Reconstruction; ePTFE.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Blood Vessel Prosthesis*
  • Female
  • Graft Occlusion, Vascular / diagnosis
  • Graft Occlusion, Vascular / epidemiology
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / prevention & control
  • Humans
  • Iliac Vein / transplantation*
  • Male
  • Middle Aged
  • Pancreatectomy*
  • Pancreaticoduodenectomy*
  • Polytetrafluoroethylene*
  • Portal Vein / surgery*
  • Retrospective Studies
  • Treatment Outcome
  • Vascular Surgical Procedures / instrumentation
  • Vascular Surgical Procedures / methods*

Substances

  • Polytetrafluoroethylene